The Clock Is Ticking as the Clot Thickens

According to the United Nations Population Division, the number of people who are over the age of 65 will approach 1.5 billion, or 16% of the population, by the year 2050. The fastest-growing segment of the population is the “oldest old,” ie, age >80. In North America and Europe, this group will jump from ≈10 million in 2010 to almost 40 million by 2050. These staggering demographic changes will increasingly challenge health care systems, as the numbers of individuals requiring medical care will progressively rise.See accompanying article on page 2552Among the leading causes of morbidity and mortality for aging individuals are venous thromboembolism (VTE) and atherothrombosis. Aging, in fact, represents one of the strongest predictors for both. Although VTE occurs in approximately 1 to 2 in every 1000 adults annually, the incidence in the oldest old rises to 1 per 100 per year.1,2 This means that in 2050, more than 500,000 individuals over the age of 85 in North America and Europe alone will develop deep vein thrombosis or pulmonary emboli, with double the fatality rates of patients less than half their age.3 On the arterial side, the outlook is even more numbing. Atherothrombosis underlies myocardial infarction, angina, stroke, and peripheral arterial disease, all of which are more frequent in the elderly. Even now, octogenarians, who represent ≈5% of the population, account for more than 30% of all myocardial infarction-related deaths,4 and this is likely to increase as the specter of obesity, accompanied by vascular complications, rises.5Delineating the mechanisms underlying the age-dependent increased risk of VTE and atherothrombosis is tantamount to identifying risk factors and developing effective preventative and therapeutic strategies. Unfortunately, advances in this field have been limited. The challenge of discerning independent age-related risk factors for thrombosis in populations …